Citation Nr: 0611348
Decision Date: 04/20/06 Archive Date: 04/26/06
DOCKET NO. 04-16 588A ) DATE
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On appeal from the
Department of Veterans Affairs Regional Office in Chicago,
Illinois
THE ISSUES
1. Entitlement to service connection of hamstring
tendonitis, right knee.
2. Entitlement to service connection of a back disability
including claimed as sacroiliac instability.
3. Entitlement to service connection of a right hip
disability including claimed as iliotibial band syndrome.
ATTORNEY FOR THE BOARD
K. Morgan, Associate Counsel
INTRODUCTION
The veteran served on active duty from March 2001 until June
2003.
This case comes before the Board of Veterans' Appeals (the
Board) on appeal from a January 2004 rating decision of the
Department of Veterans Affairs (VA) Regional Office in
Chicago, Illinois (the RO).
The issues of entitlement to service connection of a back
disability including claimed as sacroiliac instability and
entitlement to service connection of a right hip disability
including claimed as iliotibial band syndrome are addressed
in the REMAND portion of the decision below and are REMANDED
to the RO via the Appeals Management Center (AMC), in
Washington, DC.
FINDINGS OF FACT
1. The veteran has been diagnosed with right knee
tendonitis.
2. The veteran injured her right knee during service.
3. The competent and probative medical evidence of record
indicates that the veteran's right knee disability is related
to service.
CONCLUSION OF LAW
Right knee tendonitis is related to service. 38 U.S.C.A.
§ 1110 (West 2002); 38 C.F.R. § 3.303 (2005).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
The veteran is seeking entitlement to service connection of a
right knee disability which has been described as hamstring
tendonitis of the right knee.
Pertinent Law and Regulations
Service connection in general
Service connection may be granted for disability resulting
from disease or injury incurred in or aggravated by active
service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R.
§ 3.303 (2005).
In order to establish service connection for a claimed
disorder, there must be (1) medical evidence of a current
disability; (2) medical, or in certain circumstances, lay
evidence of in-service incurrence or aggravation of a disease
or injury; and (3) medical evidence of a nexus between the
claimed in-service disease or injury and the current
disability. See Hickson v. West, 12 Vet. App. 247, 253
(1999).
Continuity of symptomatology
The mere fact of an in-service injury is not enough; there
must be evidence of a chronic disability resulting from that
injury. When a chronic disease is shown in service so as to
permit a finding of service connection, subsequent
manifestations of the same chronic disease at any later date,
however remote, are service connected, unless clearly
attributable to intercurrent causes. See 38 C.F.R. §
3.303(b) (2005). In order to show a chronic disease in
service there is required a combination of manifestations
sufficient to identify the disease entity, and sufficient
observation to establish chronicity at the time, as
distinguished from merely isolated findings or a diagnosis
including the word "chronic." 38 C.F.R. § 3.303(b). When the
fact of chronicity in service is not adequately supported,
then a showing of continuity after discharge is required to
support the veteran's claim. 38 C.F.R. § 3.303(b).
The chronicity provision of 38 C.F.R. § 3.303(b) applies when
evidence, regardless of its date, establishes that a veteran
had a chronic condition in service and still has that
condition. There must be competent medical evidence unless
the evidence relates to a condition as to which lay
observation is competent to identify its existence.
Analysis
The veteran is seeking entitlement to service connection of a
right knee disability claimed as hamstring tendonitis of the
right knee. Essentially, she contends that injuries
suffered in service caused her to develop several
disabilities of the right knee. The Board notes in passing
that the veteran is service-connected for chronic pain
syndrome (claimed as patellar-femoral pain syndrome) of the
right knee and that a 10 percent disability rating has been
assigned.
On treatment at the VA in September 2003, a diagnosis of
right lower extremity tendonitis was noted. Accordingly,
current disability is indicated in the medical evidence of
record.
Concerning in-service incurrence of disease or injury, the
veteran's service medical records document ongoing in-service
treatment for a variety of right knee complaints as well as a
May 2001 complaint of having twisted the right knee during
training. July 2001 and July 2002 treatment records include
a diagnosis of tendonitis. Several treatment records include
a finding of hamstring tightness. Accordingly, in-service
incurrence of disease or injury has been met as tendonitis
was diagnosed after the May 2001 in-service injury. The
veteran's service medical records further document that she
was separated from service due to her patella-femoral pain
syndrome which arose out of the same May 2001 in-service
injury which led to the diagnosis of hamstring tendonitis in
service as documented in the July 2001 service medical
records.
Turning to the final element, medical nexus, under the
provisions of 38 C.F.R. § 3.303(b), continuity of
symptomatology can satisfy the nexus requirement. See Savage
v. Gober, 10 Vet. App. 488, 495-498 (1997). In this case,
the veteran was treated for a hamstring tendonitis in
service, is currently diagnosed with hamstring tendonitis and
has continuously sought treatment for her right knee
condition since service. Specifically, the veteran separated
from service in June 2003 and began seeking treatment for her
right knee condition at VA in August 2003. A VA treatment
record in September 2003 showed a diagnosis of hamstring
tendonitis and the veteran's February 2004 Notice of
Disagreement clearly indicated that she was continuing to
receive treatment at VA. Accordingly, the evidence of record
shows ongoing treatment for the claimed condition from the
veteran's separation from service up to the present time.
The Board notes that the September 2003 VA orthopedic
examination diagnosed only chronic pain syndrome, without a
finding of hamstring tendonitis or the veteran's other
claimed condition, patellar femoral syndrome. In an October
2003 rating decision the RO granted service connection of a
disability which it denominated as chronic pain syndrome,
right knee (claimed as patellar femoral syndrome). However,
a review of the VA treatment records and the service medical
records clearly indicate that the veteran's patellar femoral
syndrome and the hamstring tendonitis both arose out of the
same May 2001 injury and both continue to cause the veteran
to seek treatment.
Based on this record, the Board concludes that continuity of
symptomatology has been shown and medical nexus between in
the in-service injury and treatment for tendonitis and the
post-service current disability diagnosed as tendonitis is
effectively met.
Therefore, all the criteria for the establishment of service
connection have been met and, to the extent that hamstring
tendonitis is a separate disability from the service-
connected chronic pain syndrome, right knee (claimed as
patellar femoral syndrome), the benefit sought on appeal is
therefore granted.
ORDER
Entitlement to service connection of hamstring tendonitis,
right knee is granted.
REMAND
The veteran is also seeking entitlement to service connection
of a back disability including claimed as sacroiliac
instability and a right hip disability including claimed as
iliotibial band syndrome. For the reasons explained
immediately below, the Board has determined that a remand is
in order.
The veteran advised VA in her February 2004 Notice of
Disagreement that she had received treatment at the North
Chicago VA Medical Center (VAMC) in January 2004 and that
such treatment was ongoing. However, the evidence of record
includes only VA treatment records through November 2003. In
general, the VCAA provides that VA shall make reasonable
efforts to assist a claimant in obtaining evidence necessary
to substantiate a claim for VA benefits, unless no reasonable
possibility exists that such assistance would aid in
substantiating the claim. The veteran has identified the
existence of medical records which she asserts have bearing
upon the claim. The RO must therefore make reasonable
efforts to obtain these records. See 38 U.S.C.A. § 5103A.
The Board also points out that records generated by VA
facilities that may have an impact on the adjudication of a
claim are considered constructively in the possession of VA
adjudicators during the consideration of a claim, regardless
of whether those records are physically on file. See Bell v.
Derwinski, 2 Vet. App. 611, 613 (1992).
Accordingly, the case is REMANDED to the AMC for the
following action:
1. The AMC should obtain treatment
records pertaining to the veteran from
the North Chicago VAMC. Any records
obtained should be associated with the
veteran's claims file.
2. The AMC should then review the
evidence of record, including any
additional evidence obtained, and after
conducting any further evidentiary
development which it deems necessary
readjudicate the veteran's claims. If
any of the claims on appeal remain
denied, VBA should provide the veteran
with a supplemental statement of the case
(SSOC). The case should then be returned
to the Board for further consideration,
if otherwise in order.
The veteran has the right to submit additional evidence and
argument on the matter or matters the Board has remanded.
Kutscherousky v. West, 12 Vet. App. 369 (1999).
This claim must be afforded expeditious treatment. The law
requires that all claims that are remanded by the Board of
Veterans' Appeals or by the United States Court of Appeals
for Veterans Claims for additional development or other
appropriate action must be handled in an expeditious manner.
See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2005).
______________________________________________
J. A. MARKEY
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs